Predictors of hyperosmolar hyperglycemic state among adult type 1 and type 2 diabetes mellitus patients at public hospitals in Harari region, Eastern Ethiopia: A survival analysis

Background The hyperosmolar hyperglycemic state (HHS) is a rare but life-threatening complication of diabetes. Evidence on hyperglycemic emergencies, including HHS and their predictors in Ethiopia, is limited, and predictors specific to HHS are not well characterized. Therefore, this study aimed to determine the incidence of hyperosmolar hyperglycemic state and its predictors among adult diabetic patients in eastern Ethiopia. Method A retrospective cohort study was conducted among 461 adults with diabetes from January 1, 2019, to December 31, 2024. Data were collected using the Kobo Toolbox and analyzed with STATA. Survival probabilities were estimated using the Kaplan-Meier curve. Predictors of HHS were identified using the Weibull proportional hazards regression model. Hazard ratios (HR) with their respective 95% confidence intervals (CI) and p-values were computed. Results From the total of 452 patients included in the study, 45 (9.96%), 95% CI (7.51%-13.08%) developed hyperosmolar hyperglycemic state. The incidence rate of HHS was 5.36 cases per 100 person-years of observation, 95% CI (4.00-7.18), which was 3.89 and 5.76 per 100 person-years among T1DM and T2DM, respectively. Factors significantly associated with HHS included being rural area residents (AHR: 1.99, 95% CI: 1.01–3.92), having comorbidities (AHR: 3.01, 95% CI: 1.28–7.05), medication non-adherence (AHR: 2.14, 95% CI: 1.04–4.40), and lack of community health insurance (AHR: 2.04, 95% CI: 1.03–4.04). Conclusion HHS occurred more frequently among patients with T2DM. Strengthening follow-up and targeted interventions, particularly for rural residents, patients with comorbidities, those without community health insurance, and those with medication non-adherence, may reduce HHS occurrence.